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In response to Dr. Aleali's letter, I agree that it is important to stay current to avoid, as he warns, becoming a dinosaur. But I wasn't implying that physicians don't need to stay current and informed. What I suggested was that the current methods of recertification for generalists, particularly family doctors, are burdensome and out of sync with the real world of medicine. This is particularly true for family physicians, but it applies to all physicians who consider themselves providers of primary care.

Most primary care physicians customize their practices over time and according to the types of patients they see, procedures they do, and diseases they feel comfortable treating. This customization even includes the number of patients they see per day, whether they use or do not use physician extenders, and the number of specialists in the area.